| Autumn Leaves Psychiatry, Pllc | |
|
3670 S 25th E Ste 4 Idaho Falls ID 83404-4956 | |
| (208) 821-0357 | |
| Not Available |
| Full Name | Autumn Leaves Psychiatry, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3670 S 25th E Ste 4, Idaho Falls, Idaho |
| Authorized Official Name and Position | Merjurie F Ricklefs (PSYCHIATRIC NURSE PRACTITIONER) |
| Authorized Official Contact | 2088210357 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Autumn Leaves Psychiatry, Pllc 3670 S 25th E Ste 4 Idaho Falls ID 83404-4956 Ph: (208) 821-0357 | Autumn Leaves Psychiatry, Pllc 3670 S 25th E Ste 4 Idaho Falls ID 83404-4956 Ph: (208) 821-0357 |
| NPI Number | 1396326096 |
|---|---|
| Provider Enumeration Date | 04/15/2021 |
| Last Update Date | 05/06/2021 |
| Certification Date | 05/06/2021 |
| Medicare PECOS PAC ID | 5991106551 |
|---|---|
| Medicare Enrollment ID | O20210702001346 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396326096 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Merjurie Fair Ricklefs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821693094 PECOS PAC ID: 0244631802 Enrollment ID: I20210709000913 |
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